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PHM702 > Exam 4 - Rheumatoid Arthritis > Flashcards

Exam 4 - Rheumatoid Arthritis Flashcards

1
Q

What are risk factors for rheumatoid arthritis? (2)

A

sex (women), Caucasian and Native American

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2
Q

List characteristics of rheumatoid arthritis? (4)

A

variable age and onset, bilateral and generalized to smaller joints, >1 hr pain associated with use and rest, autoantibodies present

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3
Q

What are non-pharm treatments for rheumatoid arthritis? (5)

A

rest, weight loss, pain coping skills, physical/occupation therapy, surgery

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4
Q

What are nDMARDs for rheumatoid arthritis? (2)

A

NSAIDs, corticosteroids

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5
Q

What is initial pharmacologic treatment for rheumatoid arthritis?

A

DMARD monotherapy

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6
Q

What is pharmacologic treatment for persistent moderate-high disease activity rheumatoid arthritis? (3)

A

combination csDMARDs, bDMARD or tsDMARD both +/- MTX (* = short-term corticosteroids)

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7
Q

What is treatment for persistent moderate-high disease RA with prior csDMARD use other than MTX?

A

switch to MTX monotherapy

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8
Q

What is treatment for persistent moderate-high disease RA with oral MTX not at target?

A

switch to SQ MTX (potentially over addition of DMARD)

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9
Q

What is treatment for persistent moderate-high disease RA without poor prognostic factors/patient preference?

A

add additional csDMARD

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10
Q

What is treatment for persistent moderate-high disease RA with poor prognostic factors/patient preference?

A

add tsDMARD or bDMARD

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11
Q

What are the poor prognostic factors for rheumatoid arthritis? (3)

A

high disease activity, early presence of erosion, autoantibody positivity

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12
Q

What are the conventional synthetic (cs) DMARDs? (9)

A

methotrexate, leflunomide, hydroxychloroquine, sulfasalazine, gold salts, minocycline, CsA, cyclophosphamide, D-penicillamine

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13
Q

What are the biologic (b) DMARDs? (2)

A

TNF inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab) and non-TNF inhibitors (abatacept, rituximab, toclizumab, anakinra, sarilumab)

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14
Q

What are the targeted synthetic (ts; JAKis) DMARDs? (3)

A

tofacitinib, baricitinib, upadacitinib

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15
Q

What is the MOA of methotrexate?

A

folate antagonist with anti-inflammatory properties

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16
Q

How is methotrexate dosed?

A

7.5 mg qw, titrated to 15 mg

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17
Q

What are AEs of methotrexate? (3)

A

stomatitis, dyspepsia, immunosuppression

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18
Q

What are boxed warnings for methotrexate? (5)

A

GI toxicity, dermatological reactions, pneumonitis/pulmonary fibrosis, myelosuppression, increased LFTs

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19
Q

What are contraindications for methotrexate? (4)

A

pregnancy/breastfeeding, renal disease, liver disease, myelosuppression

20
Q

What is the MOA of leflunomide?

A

inhibits pyrimidine synthesis to decrease lymphocyte proliferation

21
Q

How is leflunomide dosed?

A

100 mg qd x 3, then 10-20 mg/d

22
Q

What are AEs of leflunomide? (5)

A

GI, rash, alopecia, peripheral neuropathy, HTN

23
Q

What are boxed warnings for leflunomide? (3)

A

embryo-fetal toxicity, hepatotoxicity, drug elimination may be necessary with cholestyramine

24
Q

What is the MOA of sulfasalazine?

A

unknown; metabolites have anti-inflammatory properties

25
Q

How is sulfasalazine dosed?

A

500-1000 mg/d

26
Q

What are AEs for sulfasalazine? (6)

A

GI, HA, rash, weight loss, oligospermia, hemolytic anemia

27
Q

What is the MOA of hydroxychloroquine?

A

unknown; inhibits cytokine production

28
Q

How is hydroxychloroquine dosed?

A

400-600 mg/d, then 200-400 mg/d

29
Q

What are AEs of hydroxychloroquine? (4)

A

GI, retinal damage, QTc-prolongation, skin reactions (allergic, pigmentation)

30
Q

What are the onsets of action for the csDMARDs? (4)

A

MTX = 1-2, leflunomide = 1-3, sulfasalazine = 1-3, hydroxychloroquine = 2-4 mo

31
Q

What is the order of recommended csDMARDs for initial therapy in low disease activity?

A

hydroxychloroquine > sulfasalazine > methotrexate > leflunomide

32
Q

What time frame is considered an adequate trial for TNFi biologics? Non-TNFi biologics?

A

3 mo; 6 mo

33
Q

Which TNFi biologics are SQ only? (3)

A

etanercept, adalimumab, certolizumab

34
Q

Which TNFi biologic is IV only?

A

infliximab

35
Q

What are boxed warnings for TNFi biologics? (2)

A

malignancy, opportunistic infections

36
Q

How is adalimumab dosed when on methotrexate in RA? When taken alone?

A

40 mg eow; 40 mg qw

37
Q

Which non-TNFi biologics are SQ only? (2)

A

sarilumab, anakinra

38
Q

Which non-TNFi biologic is IV only?

A

rituximab

39
Q

Which biologics MUST be given with methotrexate? (2)

A

rituximab, golimumab

40
Q

What are AEs of biologics? (2)

A

infections (URTIs/UTIs), injection site/infusion-related reactions

41
Q

What are monitoring parameters for biologics? (4)

A

CBC (all), LFT (infliximab), ANC, FLP

42
Q

What are AEs of JAKis? (4)

A

increased HDL/LDL, infections (URTIs), GI perforation, blood dyscrasias

43
Q

What are boxed warnings for JAKis? (3)

A

malignancy, opportunistic infections, thrombotic events

44
Q

What is first-line treatment for DMARD-naïve RA patients with moderate-severe disease?

A

methotrexate

45
Q

What is first-line treatment for DMARD-naïve RA patients with low (mild) disease?

A

hydroxychloroquine

46
Q

Which vaccinations are recommended during RA therapy with biologics? (3)

A

pneumococcal, influenza, hepatitis B

47
Q

What should be tested for prior to starting a biologic or JAKi? For how long? (2)

A

tuberculosis; if latent 1 month prior to starting biologic, if active after complete TB treatment

PHM702 (19 decks)

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